Soluble Triggering Receptor Expressed on Myeloid Cells-1 and Inflammatory Markers in Colorectal Cancer Surgery: A Prospective Cohort Study

Lovorka Ðerek, Dražen Servis, Adriana Unić, Lovorka Ðerek, Dražen Servis, Adriana Unić

Abstract

Background: Major abdominal surgery, including colorectal cancer (CRC) surgery, leads to systemic inflammatory response syndrome that can be detected and monitored with inflammatory markers testing. The aims of the study were to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) in following the inflammatory response in CRC surgery and postoperative period, as well as to determine if duration of the surgery and the time that the colon has been opened during the surgery (open colon time [OCT]) reflect a larger surgical stress through inflammatory markers rise.

Methods: The study included 20 patients who underwent CRC surgery and 19 healthy volunteers from June 2011 to September 2012. We determined inflammatory markers 1 day before surgery (T0), 24 h (T1), 48 h (T2), and 7 days after the surgery (T3). All statistical analyses were calculated using MedCalc Statistical Software version 14.8.1 (MedCalc Software bvba, Ostend, Belgium).

Results: Concentrations of CRP, PCT, and IL-6 in all measurement times were statistically different and sTREM-1 did not yield statistical significance. A weak positive correlation was found between IL-6 in T1 and T2 with the duration of the surgery (T1: r = 0.4060, P < 0.0001; T2: r = 0.3430, P < 0.0001) and OCT (T1: r = 0.3640, P < 0.0001, T2: r = 0.3430, P < 0.0001). A weak positive correlation between CRP in T2 and OCT (r = 0.4210, P < 0.0001) was also found. The interconnectivity of tested parameters showed a weak positive correlation between CRP and IL-6 in T1 (r = 0.3680; P < 0.0001), moderate positive correlation in T2 (r = 0.6770; P < 0.0001), and a strong positive correlation in T3 (r = 0.8651; P < 0.0001).

Conclusions: CRP, IL-6, and PCT were shown to be reliable for postoperative monitoring. Simultaneous determination of CRP and IL-6 might not be useful as they follow similar kinetics. sTREM-1 might not be useful in CRC postoperative monitoring.

Trial registration: www.ClinicalTrials.gov, NCT01244022;https://www.clinicaltrials.gov/ct2/show/NCT01244022?term=01244022&rank=1.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Time-course of the changes in CRP, IL-6, procalcitonin and soluble triggering receptor expressed on myeloid cells-1 concentrations in four consecutive measurement time points. *P < 0.05, CRP before surgery versus 24 h after surgery; †P < 0.05, CRP 24 h after surgery versus 48 h after surgery; ‡P < 0.05, CRP 48 h after surgery versus 7 days after surgery. §P < 0.05, IL-6 before surgery versus 24 h after surgery; ||P < 0.05, IL-6 24 h after surgery versus 48 h after surgery; ¶P < 0.05, IL-6 48 h after surgery versus 7 days after surgery. **P < 0.05, PCT before surgery versus 24 h after surgery; ††P < 0.05, PCT 24 h after surgery versus 48 h after surgery; ‡‡P < 0.05, PCT 48 h after surgery versus 7 days after surgery. CRP: C-reactive protein; IL-6: Interleukin 6; sTREM-1: Soluble triggering receptor expressed on myeloid cells-1; PCT: Procalcitonin.

References

    1. Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: A systematic review. Surgery. 2015;157:362–80. doi: 10.1016/j.surg.2014.09.009.
    1. Oberhofer D, Juras J, Pavicić AM, Rancić Zurić I, Rumenjak V. Comparison of C-reactive protein and procalcitonin as predictors of postoperative infectious complications after elective colorectal surgery. Croat Med J. 2012;53:612–9. doi: 10.3325/cmj.2012.53.612.
    1. Su L, Liu D, Chai W, Liu D, Long Y. Role of sTREM-1 in predicting mortality of infection: A systematic review and meta-analysis. BMJ Open. 2016;6:e010314. doi: 10.1136/bmjopen-2015-010314.
    1. Pontrelli G, De Crescenzo F, Buzzetti R, Calò Carducci F, Jenkner A, Amodio D, et al. Diagnostic value of soluble triggering receptor expressed on myeloid cells in paediatric sepsis: A systematic review. Ital J Pediatr. 2016;42:44. doi: 10.1186/s13052-016-0242-y.
    1. Lin CH, Hsieh SC, Keng LT, Lee HS, Chang HT, Liao WY, et al. Prospective evaluation of procalcitonin, soluble triggering receptor expressed on myeloid cells-1 and C-reactive protein in febrile patients with autoimmune diseases. PLoS One. 2016;11:e0153938. doi: 10.1371/journal.pone.0153938.
    1. Essa ES, Elzorkany KM. STREM-1 in patients with chronic kidney disease on hemodialysis. APMIS. 2015;123:969–74. doi: 10.1111/apm.12459.
    1. Jérémie L, Amir B, Marc D, Sébastien G. The triggering receptor expressed on myeloid cells-1: A new player during acute myocardial infarction. Pharmacol Res. 2015;100:261–5. doi: 10.1016/j.phrs.2015.07.027.
    1. Halim B, Özlem T, Melek Ç, Münip Hakan Y, Cevval U, Gönül DH, et al. Diagnostic and prognostic value of procalcitonin and sTREM-1 levels in sepsis. Turk J Med Sci. 2015;45:578–86. doi: 10.3906/sag-1401-103.
    1. Lu Z, Liu Y, Dong YH, Zhan XB, Du YQ, Gao J, et al. Soluble triggering receptor expressed on myeloid cells in severe acute pancreatitis: A biological marker of infected necrosis. Intensive Care Med. 2012;38:69–75. doi: 10.1007/s00134-011-2369-z.
    1. Wu Y, Wang F, Fan X, Bao R, Bo L, Li J, et al. Accuracy of plasma sTREM-1 for sepsis diagnosis in systemic inflammatory patients: A systematic review and meta-analysis. Crit Care. 2012;16:R229. doi: 10.1186/cc11884.
    1. Rivera-Chavez FA, Minei JP. Soluble triggering receptor expressed on myeloid cells-1 is an early marker of infection in the surgical Intensive Care Unit. Surg Infect (Larchmt) 2009;10:435–9. doi: 10.1089/sur.2009.030.
    1. Li L, Zhu Z, Chen J, Ouyang B, Chen M, Guan X, et al. Diagnostic value of soluble triggering receptor expressed on myeloid cells-1 in critically-ill, postoperative patients with suspected sepsis. Am J Med Sci. 2013;345:178–84. doi: 10.1097/MAJ.0b013e318253a1a6.
    1. Crucitti A, Corbi M, Tomaiuolo PM, Fanali C, Mazzari A, Lucchetti D, et al. Laparoscopic surgery for colorectal cancer is not associated with an increase in the circulating levels of several inflammation-related factors. Cancer Biol Ther. 2015;16:671–7. doi: 10.1080/15384047.2015.1026476.
    1. Pavic M, Bronic A, Milevoj Kopcinovic L. Procalcitonin in systemic and localized bacterial infection. Biochem Med. 2010;20:236–41. doi: 10.11613/BM.2010.029.
    1. Hunziker S, Hügle T, Schuchardt K, Groeschl I, Schuetz P, Mueller B, et al. The value of serum procalcitonin level for differentiation of infectious from noninfectious causes of fever after orthopaedic surgery. J Bone Joint Surg Am. 2010;92:138–48. doi: 10.2106/JBJS.H.01600.
    1. Su L, Han B, Liu C, Liang L, Jiang Z, Deng J, et al. Value of soluble TREM-1, procalcitonin, and C-reactive protein serum levels as biomarkers for detecting bacteremia among sepsis patients with new fever in Intensive Care Units: A prospective cohort study. BMC Infect Dis. 2012;12:157. doi: 10.1186/1471-2334-12
    1. Sokolov M, Angelov K, Vasileva M, Atanasova MP, Vlahova A, Todorov G, et al. Clinical and prognostic significance of pathological and inflammatory markers in the surgical treatment of locally advanced colorectal cancer. Onco Targets Ther. 2015;8:2329–37. doi: 10.2147/OTT.S82958.
    1. Hasibeder A, Stein P, Brandwijk R, Schild H, Radsak MP. Evaluation and validation of the detection of soluble triggering receptor expressed on myeloid cells 1 by enzyme-linked immunosorbent assay. Sci Rep. 2015;5:15381. doi: 10.1038/srep.
    1. Mauri C, Bosma A. Immune regulatory function of B cells. Annu Rev Immunol. 2012;30:221–41. doi: 10.1146/annurev-immunol-020711-074934.
    1. Uusitalo-Seppälä R, Koskinen P, Leino A, Peuravuori H, Vahlberg T, Rintala EM, et al. Early detection of severe sepsis in the emergency room: Diagnostic value of plasma C-reactive protein, procalcitonin, and interleukin-6. Scand J Infect Dis. 2011;43:883–90. doi: 10.3109/00365548.2011.600325.
    1. Dati F, Schumann G, Thomas L, Aguzzi F, Baudner S, Bienvenu J, et al. Consensus of a group of professional societies and diagnostic companies on guidelines for interim reference ranges for 14 proteins in serum based on the standardization against the IFCC/BCR/CAP reference material (CRM 470). International Federation of Clinical Chemistry. Community Bureau of Reference of the Commission of the European Communities College of American Pathologists. Eur J Clin Chem Clin Biochem. 1996;34:517–20.
    1. Andersson M, Rubér M, Ekerfelt C, Hallgren HB, Olaison G, Andersson RE, et al. Can new inflammatory markers improve the diagnosis of acute appendicitis? World J Surg. 2014;38:2777–83. doi: 10.1007/s00268-014-2708-7.
    1. Maurus M, Liewald C, Gorki H, Hönicka M, Liebold A. Do we need another inflammation marker in cardiac surgery? Thorac Cardiovasc Surg. 2014;62:SC136. doi: 10.1055/s-0034-1367397.
    1. Duvillard L, Ortega-Deballon P, Bourredjem A, Scherrer ML, Mantion G, Delhorme JB, et al. A case-control study of pre-operative levels of serum neutrophil gelatinase-associated lipocalin and other potential inflammatory markers in colorectal cancer. BMC Cancer. 2014;14:912. doi: 10.1186/1471-2407-14
    1. Guthrie GJ, Roxburgh CS, Horgan PG, McMillan DC. Does interleukin-6 link explain the link between tumour necrosis, local and systemic inflammatory responses and outcome in patients with colorectal cancer? Cancer Treat Rev. 2013;39:89–96. doi: 10.1016/j.ctrv.2012.07.003.
    1. Andersson B, Ansari D, Nordén M, Nilsson J, Andersson R. Surgical stress response after colorectal resection. Int Surg. 2013;98:292–9. doi: 10.9738/INTSURG-D-12-00009.1.
    1. Giaccaglia V, Salvi PF, Antonelli MS, Nigri G, Pirozzi F, Casagranda B, et al. Procalcitonin reveals early dehiscence in colorectal surgery: The PREDICS study. Ann Surg. 2016;263:967–72. doi: 10.1097/SLA.0000000000001365.
    1. Sparreboom CL, Wu Z, Dereci A, Boersema GS, Menon AG, Ji J, et al. Cytokines as early markers of colorectal anastomotic leakage: A systematic review and meta-analysis. Gastroenterol Res Pract. 2016;2016:3786418. doi: 10.1155/2016/3786418.
    1. Reisinger KW, Poeze M, Hulsewé KW, van Acker BA, van Bijnen AA, Hoofwijk AG, et al. Accurate prediction of anastomotic leakage after colorectal surgery using plasma markers for intestinal damage and inflammation. J Am Coll Surg. 2014;219:744–51. doi: 10.1016/j.jamcollsurg.2014.06.011.
    1. Dupuy AM, Philippart F, Péan Y, Lasocki S, Charles PE, Chalumeau M, et al. Role of biomarkers in the management of antibiotic therapy: An expert panel review: I-currently available biomarkers for clinical use in acute infections. Ann Intensive Care. 2013;3:22. doi: 10.1186/2110-5820-3
    1. Lemarié J, Barraud D, Gibot S. Host response biomarkers in sepsis: Overview on sTREM-1 detection. Methods Mol Biol. 2015;1237:225–39. doi: 10.1007/978-1-4939-1776-1_17.
    1. Determann RM, Weisfelt M, de Gans J, van der Ende A, Schultz MJ, van de Beek D, et al. Soluble triggering receptor expressed on myeloid cells 1: A biomarker for bacterial meningitis. Intensive Care Med. 2006;32:1243–7. doi: 10.1007/s00134-006-0240-4.
    1. Yu Y, Zhu C, Liu C, Gao Y, Yin R, Cao J, et al. Diagnostic performance of soluble triggering receptor expressed on myeloid cells-1 in ventilator-associated pneumonia of patients with ischemic stroke. Can J Infect Dis Med Microbiol. 2017;2017:9513690. doi: 10.1155/2017/9513690.
    1. Charles PE, Noel R, Massin F, Guy J, Bollaert PE, Quenot JP, et al. Significance of soluble triggering receptor expressed on myeloid cells-1 elevation in patients admitted to the intensive care unit with sepsis. BMC Infect Dis. 2016;16:559. doi: 10.1186/s12879-016-1893-4.
    1. Ni Choileain N, Redmond HP. Cell response to surgery. Arch Surg. 2006;141:1132–40. doi: 10.1001/archsurg.141.11.1132.

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